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Facility Use Application
Facility Use Application
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* Indicates required question
Email
*
Your email
Individual/Organization:
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
City:
*
Your answer
State:
*
Your answer
Zip Code:
*
Your answer
Phone:
*
Your answer
Description of usage:
*
Your answer
Estimated number of
Youth
participants (
ages 0-12
)
Your answer
Estimated number of
Teen
participants (
ages 13-18
)
Your answer
Estimated number of
Adult
participants (
ages 19-54
)
Your answer
Estimated number of
Senior
participants (
ages 55+
):
Your answer
What percentage of participants are residents of ISD 110?
100%
75%
Less than 75%
Clear selection
Will a participant fee or admission be charged?
Choose
Yes
No
Amount of participant fee or admission:
Your answer
Will concessions be sold?:
Choose
Yes
No
Building Requested:
Bayview Elementary School
Laketown Elementary School
Southview Elementary School
Waconia Enrichment Center
Waconia High School
Waconia Middle School
Area Desired for use:
Your answer
Date(s) of use:
Your answer
Start and End times for each date:
Your answer
Special Requests:
Screen
Video/Power Point Projector
Podium
Microphone
TV/VCR
Spotlights
Chairs
Tables
Other
Number of chairs needed?
Your answer
Number of tables needed?
Your answer
Signature of Applicant/Agent:
Your answer
A copy of your responses will be emailed to the address you provided.
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